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Individual
MR. JACK RANDALL WITHENSHAW
Active
Individual
MR. JACK RANDALL WITHENSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SW, LMFT
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6802065221
MI
106H00000X
Marriage & Family Therapist
Primary
4101006147
MI
Other
Enumeration date
07/02/2008
Last updated
07/02/2008
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